LYMPHATIC MASSAGE
Season 1, Episode 5
This episode explores the utility of manual lymphatic drainage (MLD) in cosmetic procedures. This article begins by discussing lymphedema, its causes, and traditional treatments, highlighting MLD as a key component of complete decongestive therapy. The article then examines the proposed mechanisms by which MLD improves lymphatic drainage, including increasing lymphatic vessel transport, interstitial pressure, and venous return. It reviews different MLD techniques like Vodder, Földi, Casley-Smith, and Leduc, detailing their specific hand movements and approaches. Finally, it discusses the potential applications of MLD in various plastic surgery procedures, such as abdominoplasty, breast augmentation, facelifts, and extremity contouring, concluding that more research is needed to fully understand its benefits. The authors suggest that MLD can aid in recovery by reducing swelling, pain, and fibrosis, ultimately improving patient satisfaction.
Comprehensive Study Guide
Short Answer Questions
Instructions: Please answer the following questions in 2-3 sentences each.
What is lymphedema, and what causes it?
Describe the role of manual lymphatic drainage (MLD) in complete decongestive therapy (CDT).
What are some proposed mechanisms of action for how MLD improves lymphatic drainage?
Name the four main methods of MLD.
Why is MLD usually initiated with treatment of the central or proximal region of the body?
In what types of patients was MLD originally utilized?
Explain the use of MLD in patients undergoing abdominal liposuction.
What benefits may MLD have in patients undergoing breast augmentation or mastopexy?
What role might MLD play in postoperative recovery from facial procedures like facelifts?
What is the main reason for the need for more research on MLD in aesthetic procedures?
Short Answer Key
Lymphedema is a condition characterized by inadequate drainage of lymphatic vessels, leading to an accumulation of protein-rich interstitial fluid. It can be either primary (inherited) or secondary (acquired), with secondary causes like surgery, cancer treatment, and trauma being more common.
MLD is a component of CDT used in the treatment of lymphedema; it is a massage technique thought to decrease fibrosis and lymphatic re-routing to functioning lymphatic channels. It aids in lymphatic restoration following potential lymphatic disruption during surgery.
Proposed mechanisms include increasing lymphatic vessel transport through increased contractions, increasing interstitial pressure to improve lymphatic reabsorption, decreasing distal lymphatic pressure to enhance uptake, and improving accessory lymphatic routes. Some studies also suggest MLD can improve systemic venous return.
The four main methods of MLD are the Vodder method, the Földi technique, the Casley-Smith method, and the Leduc method.
MLD usually begins with treatment of the central or proximal region to clear the pathways closer to the body's core, making it easier for fluid from the distal regions to flow and drain.
MLD was originally utilized in post-mastectomy breast-cancer patients prior to undergoing reconstruction, with notable improvements in pain and swelling.
In abdominal liposuction, the superficial lymphatic system is at a high risk of disruption, potentially resulting in lymphatic stasis. MLD in this context aims to reduce edema, fibrosis, and provide analgesia, improving patient comfort and quality of life.
While less studied than in reconstructive procedures, MLD has been incorporated into postoperative protocols for breast augmentation and mastopexy. Some studies suggest it may be beneficial due to altered lymphatic drainage following breast procedures.
MLD may help in mitigating complications like swelling and pain after facial procedures like injectables, fillers, botulinum toxin injections, and facelifts. It is believed to improve postoperative edema, particularly in the periorbital region after eyelid procedures.
Due to the increasing number of patients undergoing cosmetic procedures and the potential benefits of MLD in promoting recovery and improving outcomes, more research is needed to fully understand its efficacy and applications in aesthetic procedures.
Key Terms
Lymphedema: A condition characterized by the accumulation of protein-rich fluid in the interstitial space due to inadequate lymphatic drainage.
Manual Lymphatic Drainage (MLD): A gentle massage technique used to stimulate the lymphatic system, reduce fluid buildup, and promote lymphatic circulation.
Complete Decongestive Therapy (CDT): A comprehensive treatment approach for lymphedema, including skin care, exercise, compression garments, and manual lymphatic drainage.
Interstitial Fluid: Fluid that fills the spaces between cells in the body.
Lymph: Fluid circulating through the lymphatic system, containing white blood cells and waste products.
Lymphatic Vessels: A network of vessels throughout the body that transport lymph fluid.
Fibrosis: The thickening and scarring of connective tissue, often occurring as a result of inflammation.
Lymphostasis: Stagnation or obstruction of lymph flow.
Vodder Method: A specific MLD technique developed by Emil Vodder, emphasizing circular movements of the thumb and specialized hand movements to direct fluid across anastomoses.
Földi Technique: An off-shoot of the Vodder technique, the Földi technique utilizes similar hand movements described previously, with the addition of a period of increased pressure followed by a relaxation phase. The Földi technique also incorporates the “encircling” stoke to help reduce edema.
Casley-Smith Method: An MLD method that added the technique consisting of using the side of the hand over specific watershed areas between distinct skin lymph territories with a slow and gentle “efflurage” maneuver.
Leduc Method: An MLD method that added "call-up" and "reabsorption" maneuvers to sequentially promote lymphatic uptake in the distal to proximal regions of lymphatic uptake.
Anastomoses: Connections between the body’s fluid drainage pathways, allowing fluid to be redirected.
Lymphatic Re-Routing: The process of directing lymph flow around impaired lymph nodes or vessels toward healthy ones.
